132例卒中相关性肺炎临床分析

发布时间：2019-01-09 07:59

【摘要】：目的探讨SAP的感染情况和病死率,以及影响其发展的重要因素;分析痰培养病原菌的种类。方法选择2014年9月至2015年9月在宁夏医科大学总医院住院的1324例脑卒中患者,其中包括1059例脑梗死患者和265例脑出血患者,分析我院SAP的感染情况;将合并肺炎者作为SAP组,共132例,未合并肺炎者132例为非SAP组,对患者基本信息(年龄、性别)、既往情况(包括糖尿病、心脏病、慢性肺病、卒中史、吸烟史)、临床症状{包括NIHSS评分(NIH Stroke Scale,NIHSS)、吞咽障碍、意识障碍}、入院后治疗{如鼻饲治疗、抑酸剂{质子泵抑制剂(Proton pump inhibitors,PPIs)及H2受体阻滞剂(histamine2-receptor antagonists,H2Ras)}的使用、脱水剂的使用}及其他情况(住院费用、住院天数)进行统计分析。全部数据采取SPSS19.0统计,组间定量资料应用t检验,对定性资料采用c2检验,筛选出影响SAP发生的因素(检验水准a=0.05)。之后将上述因素进行Logistic回归;同时,整理出痰培养的病原菌分布情况及药敏结果。结果1.1324例脑卒中病人中合并SAP者132例,SAP发生率为9.97%,其中脑梗死87例,占SAP组的65.9%,脑出血45例,占SAP组的34.1%。脑卒中患者总的病死人数为10人,病死率为0.76%,SAP组病死人数为5人,病死率为3.79%,原因分别为脑干功能衰竭(2例)、脑疝(1例)、肺炎、呼吸功能衰竭(1例)及多脏器功能衰竭(1例);非SAP组死亡0人,死亡率为0%,两组死亡率无明显差异(c2=3.262,P0.05)。2.SAP组的平均住院天数和费用均明显大于非SAP组(P0.05)。3.单因素分析时,年龄(≥65岁)、性别、卒中类型、心脏病、NIHSS评分(≥10分)、意识障碍、吞咽障碍、抑酸剂、脱水剂使用、鼻饲治疗等10个因素两组间对比差别有统计学意义(P0.05)。4.二元Logistic回归后,得出年龄、鼻饲治疗、使用脱水剂、NIHSS评分(≥10分)可能为SAP独立的危险因素。5.SAP组132例患者中送检痰培养者59例(44.7%),共送检痰培养标本165例,培养出病原体18种,44株,检出病原菌者101例,检出率为76.52%,其中检出革兰氏阴性杆菌占88.64%,分别为鲍曼不动杆菌、大肠杆菌、肺炎克雷伯杆菌、铜绿假单胞菌、流感嗜血杆菌等;革兰氏阳性球菌占4.55%;真菌占6.82%。6.病原菌及其对常用抗生素敏感性大小:鲍曼不动杆菌敏感的抗菌药物为复方新诺明、米诺环素、亚胺培南等;大肠杆菌敏感的抗菌药物为阿米卡星、头孢替坦、亚胺培南等;肺炎克雷伯杆菌敏感的抗菌药物为亚胺培南、左氧氟沙星、头孢他啶等;铜绿假单胞菌敏感的抗菌药物是阿米卡星、亚胺培南、左氧氟沙星等;金黄色葡萄球菌敏感的抗菌药物有替考拉宁、万古霉素、莫西沙星等。结论1.年龄(≥65岁)、NIHSS评分(≥10分)可能为SAP的独立危险因素;2.卒中相关性肺炎患者痰培养病原体多为革兰氏阴性杆菌,包括鲍曼不动杆菌、大肠杆菌等;革兰氏阳性球菌以金黄色葡萄球菌为主,真菌以白色念珠菌为主。
[Abstract]:Objective to investigate the infection and mortality of SAP and the important factors affecting its development, and to analyze the types of pathogenic bacteria in sputum culture. Methods 1324 stroke patients, including 1059 patients with cerebral infarction and 265 patients with cerebral hemorrhage, who were hospitalized in General Hospital of Ningxia Medical University from September 2014 to September 2015, were selected to analyze the infection of SAP in our hospital. There were 132 patients with pneumonia as SAP group, 132 patients without pneumonia as non-SAP group. The basic information (age, sex), past condition (including diabetes mellitus, heart disease, chronic lung disease, stroke history, smoking history) of the patients were analyzed, including diabetes mellitus, heart disease, chronic lung disease, stroke history and smoking history. Clinical symptoms {including NIHSS score (NIH Stroke Scale,NIHSS), dysphagia, disturbance of consciousness}, post-admission treatment {such as nasal feeding, acid suppressant {proton pump inhibitor (Proton pump inhibitors,PPIs] and H 2 receptor blocker (histamine2-receptor antagonists,) Use of H2Ras}, use of dehydrating agent} and other conditions (hospitalization costs, hospital days) for statistical analysis. All the data were collected by SPSS19.0 statistics, the quantitative data between groups were tested by t test, and the qualitative data were analyzed by c2 test. The factors affecting the occurrence of SAP were screened out (test level a0. 05). After that, the above factors were analyzed by Logistic regression, and the distribution of pathogenic bacteria and drug sensitivity of sputum culture were sorted out. Results among the 1.1324 stroke patients, 132 cases were complicated with SAP, and the incidence of SAP was 9.97. There were 87 cases of cerebral infarction (65.9% of SAP group) and 45 cases of cerebral hemorrhage (34.1% of SAP group). The total number of patients with stroke was 10, the mortality was 0.76%, and the mortality was 3.79 in SAP group. The causes were brainstem failure (2 cases), hernia (1 case) and pneumonia. Respiratory failure (1 case) and multiple organ failure (1 case); There was no significant difference in mortality between the two groups (c2n3.262, P0.05). The average hospitalization days and expenses in 2.SAP group were significantly higher than those in non-SAP group (P0.05). In univariate analysis, age (鈮，

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